Introduction: The aim of our study was to determine the prevalence of steatorrhea and exocrine pancreatic insufficiency (EPI) and their relationship to nutritional status and HIV stage in a population of children HIV infection. Our hypothesis was that a clinically significant proportion of children with HIV infection has exocrine pancreatic dysfunction. Methods: Children with perinatally acquired HIV-infection attending the CHOP Special Immunology Clinic were consecutively enrolled after informed consent. Exclusion criteria were: age <1-year, therapy with mineral oil laxatives, and being in medical foster care. History of diarrhea, hepatobiliary disease, pancreatitis, gastrostomy feeds and antiretroviral therapy known to be associated with diarrhea (Nelfinavir). HIV stage (clinical class: N to C; immune status: 1 to 3) was obtained for each subject. Z-scores were computed for weight (WAZ), height (HAZ) and weight for height (WHZ). A random fecal specimen was assayed for fecal elastase-1 (FE-1 in (g/g of stool) using ELISA (ScheBo Tech GmBH, Wettenberg, Germany). EPI was defined as FE-1 < 200 (g/g. Steatorrhea was assessed by Sudan III stain (Mayo Clinic Labs, Rochester MN) using the method of Drummey. T-tests were used to compare the clinical characteristics of the study subjects and non-participants, and those with and without steatorrhea. Significance was defined as a p-value of < 0.05.